Zhibing Yang, Yiran Liu, Haoran Yang
Chronic dermatological conditions impose a significant burden on global health and quality of life. The etiology of these disorders is multifaceted, driven by complex interactions between endogenous factors and the "skin exposome", which comprises a person's environmental exposure and lifestyle. While digital health systems (DHSs) have transformed the management of numerous chronic diseases, a unified framework that captures the dynamic interplay of environment, behavior, and skin physiology has not been fully established to date. Therefore, this review proposes and evaluates a holistic "environment-behavior-skin health" integrated management paradigm. It aims to examine how DHSs can be leveraged to track external determinants and individual behaviors to facilitate personalized skin health management. A comprehensive review of relevant literature from the past 5 years was conducted across medical, public health, and computer science databases. The study analyzed digital technologies, environmental and behavioral influencing factors, and the application of artificial intelligence (AI) in dermatology. The review identifies that key DHS technologies provide the infrastructure necessary to elucidate the skin exposome. It elucidates how behavioral factors and environmental determinants influence skin health through five core physiological pathways. While AI has achieved a high level of proficiency in image-based diagnosis, current applications often lack integration with longitudinal lifestyle and environmental data. Moving beyond traditional visual assessments, the integration of multimodal data via DHSs enables a shift from reactive, symptomatic treatment to proactive, precision dermatology. By utilizing AI to synthesize environmental sensing and behavioral tracking data, the proposed "environment-behavior-skin health" paradigm offers a promising pathway for elucidating complex disease mechanisms and delivering tailored interventions for chronic skin disease management.